3 - PSY - Anxiety Disorders Flashcards
Which four features distinguish pathological anxiety from normal anxiety
autonomy - no/min env trigger
intensity - exceeds pt capacity to deal with discomfort
Duration = Sx are persistent
Behaviour - impairs function +/or results in disabling behaviours
2 classifications of anxiety disorders?
constant - GAD
episodic - Phobias, panic, PTSD, OCD
Psych arousal Sx
worrying thoughts irritable noise sensitive restless fearful anticipation poor concentration
Sleep disturbance Sx
insomnia
night terrors
Muscle tension Sx
tremors
aches
Autonomic arousal Sx
dry mouth diarrhoea difficulty breathing palpitations chest discomfort frequent and urgent urination
4 components of the cycle of anxiety?
thoughts
behaviour
emotions
bodily responses
Generalised Anxiety Disorder - criteria
neither situational or episodic
Sx involve elements of - Apprehension, Motor tension, Autonomic over activity
general and persistent psych and somatic anxiety Sx on most days for at least several weeks
Panic disorder - ICD 10 criteria
- several attacks within one month
- circumstances with no objective danger
- not confined to known or predictable situations
- relatively free from anxiety Sx between attacks
Panic disorder - Sx
unpredictable panic attacks sudden crescendo of severe anxiety catastrophic cognition (im dying) Short lived (<10 mins normally)
Agoraphobia - icd criteria
psych and auto Sx primarily from anxiety and not secondary to other Sx
Anxiety restricted to at least two of following - crowds, public places, travelling alone, travelling away from home
avoidance of phobic situation = prominent feature
Social phobia - Sx
fear of being focus of attention
Sx restricted to situation/thinking about situation
Common Sx - blushing, shaking, fear of vomiting, urgency/frequency
Avoidance
Characteristics of OCD
obsessive Sx (thoughts, impulses, images) +/or compulsive acts or rituals - causing distress + interferes with activities
What do OCD Sx frequently co exist with
schizophrenia
tourette’s
depression
Obsessions - describe
- thoughts ideas images
- repetitive
- excessive/unreasonable
- unpleasant (no pleasure)
- originate in mind of patient
Compulsions - describe
- physical act
- excessive/unreasonable
- repetitive
- resisted by patient
- unpleasant (may relieve tension/anxiety)
- originates in mind of pt
rule these out as causes of anxiety before reaching a psych diagnosis
drugs drug withdrawal cardiac arrhythmias neuro (seizures) hypoxia (CHF, COPD, angina, anaemia) Metabolic (acidosis, hyper/hypo thermia) endocrine (thyroid)
How do patients manage their own anxiety?
Avoidance and Safety behaviours
NICE step care approach - 4 steps
1 - psychoeducation and active monitoring
2 - guided self help and low intensity psych interventions
3 - high intensity psych Tx (CBT) or drug Tx
4 - referral to secondary care - MDT approach
CBT methods for phobias and OCD
OCD - exposure and response prevention
Phobias - systematic desensitisation or graded exposure
4 types of meds used to Tx anxiety
Antidepressants
Beta Blockers
Benzos
Antipsychotics (beneficial in severe cases)
Antidepressants use in anxiety + counselling
all are anxiolytic
warn pt of possible increase in anxiety in initial period
Benzos - short and long half life examples - use - beware of…?
short half life - lorazepam
long half life - diazepam
use in short term acute management (<4 weeks) as can be addictive
can reduce psych Tx efficacy
Acute stress reaction - describe briefly
brief response to severely stressful events
acute stress reaction Sx
anxiety/depression
pts may already use coping strategies (denial, avoidance)
alcohol excess common
(numbness, detachment, derealisation, insomnia, restless, nger etc)
Management of Acute stress reaction
reduce emotional response by talking about it encouraging but not forcing recall learn coping skills anxiolytic if severe anxiety hypnotics if severe sleep disturbance
Adjustment disorder - describe briefly
psych reaction to new circumstance
related to and in proportion to stressful event
most lasts a few months
Adjustment disorder - Sx
anxiety/depression/irritable autonomic arousal Sx occasional outbursts Alcohol/drug abuse common impaired social Fx more gradual onset than acute stress reaction
Adjustment disorder - mgmt
help resolve change
prevent avoidance and denial
relieve anxiety through talk
consider talking therapy referral
Sx indicating abnormal reaction to loss (abnormal grief)
- guilt about things other than actions at time of death
- ‘im better off dead/i shouldve died with them’
- morbid preoccupation with worthlessness
- psychomotor retardation
- prolonged + serious Fx impairment
- hallucinations beyond hearing/seeing deceased person transiently
PTSD core triad of Sx
hyperarousal
re-experiencing
avoidance
Other Sx of PTSD
depressive + guilt
substance use for coping
Sx may begin quickly after, rarely >6months after
PTSD management
Psych Tx - education, CBT, Eye movement desensitisation and reprocessing
bio - antidepressants
social - avoid substances, educate family, reintegration to society
